Sunday, December 29, 2013

Village Festivals, Social Capital and Soft Power

La Fête de la Sagesse et la Richesse -- This past Saturday, a friend took us to a festival in a village near Dabou, about 90 minutes outside of Abidjan.  There was music, dancing, food, colorful outfits, relentless sun, and an endless ceremony with long-winded speeches.  It was a lot of fun.  In particular, there was lots of music and dancing, both traditional African dance and more modern stuff, in which I participated.

Being in the village, rather than Abidjan, was much closer to the Western conception of "Africa."  We weren't even the only white people at the festival, but white people are clearly a rarity in those parts, and I was an object of fascination.  Barefoot children followed me around.  Someone asked me if my hair was a wig.  They all wanted to touch my arm hair, as they'd apparently never seen anything like it.  I told them that I had the blood of the wolf.

Christmas in Abidjan -- There are some spectacular displays of Christmas lights here.  The bridge to Plateau is lit with Christmas lights shaped into beautiful, colorful flowers.  I assume that the government pays for this, and you can argue with the decision to prioritize funds for this purpose, but I do think there is something to be said for creating an attractive and happy environment for citizens.  Many private establishments also have impressive displays of Christmas decorations.

Queueing and Social Capital -- At the village festival, there was a lunch buffet for a group of us.  Even among our relatively wealthy group, the social capital was absolutely atrocious, with people shamelessly cutting each other to get ahead in the buffet line.  My initial impression has been that social capital is actually worse among the wealthy here, perhaps related to an increased sense of entitlement.

I've been noticing the lack of social capital a bit more in recent days.  I went out to buy a couple of things on December 24, a busy shopping day, and there was a disgraceful amount of cutting and other uncharitable behavior.

That being said, these are minor points, and I've found most of my business dealings to be quite honest.  Prices aren't always fixed, so people might charge me a bit extra for being Western, but people don't try to cheat me outright.  I've never given someone money for a good that was broken or a service that went unperformed.  

Soft Power -- The U.S. has a great deal of cachet over here.  A cabbie recently told me that even having a brother or a cousin in the U.S. can gain one a great deal of status.

I had a run of five cab drivers in a row who told me that their dream is to move to the U.S.  One had saved up $4,000 for his application, only to have the money stolen through a fraudulent service (very common here).  Another is in the process of trying to save up $8,000.  These are shocking sums for people who probably make about $10-$20 a day.  The driver who is saving towards his $8,000 goal says he's been saving money for 10 years now, ever since he was 18.  Most of them hope to drive taxis over in the U.S.  Such a tragedy that we make it so difficult for them to get over to the U.S.

Tuesday, December 24, 2013

Expatriate Conversation

This was another world in Malabo, the world of the colonialist.  Or better, ex-colonialist.  An African servant was passing out the drinks, another tended Guillermo and Marisol's small son, and a third prepared the fire for cooking.  The hors d'oeuvres had been imported from Cameroon and Spain.  The style of the conversation was the kind one seems to find among expatriates in almost every developing country I know: a combination of gossip about leading figures, complaints about "the system" and "the people," and great cynicism. 
That's from Robert Klitgaard's Tropical Gangsters, written in Equatorial Guinea in 1990, but it could have been written in Abidjan in 2013.  Although in fairness the U.S. Foreign Service crowd is not like this.  I've found them to be culturally sensitive, and they are not integrated enough into Ivorian life to know any interesting gossip.  The UN crowd on the other hand...

Sunday, December 22, 2013

Families, Governance and Stability

More observations from December in Abidjan:

Culture of Family Making -- There are 21 million people in Cote d'Ivoire in 2013.  There are expected to be 30 million by 2030.  When I spend time around Ivorians, it's not hard to see why.  Making a family is just such a big part of the culture here.  I've yet to meet a cab driver who doesn't have a wife and kids.  I haven't discussed this issue in detail with people, but there doesn't seem to be any concept of deciding whether one wants a wife and family, as we do in the U.S.  Getting married and having babies is what one does here.  My colleagues made fun of me recently for saying that Sheila and I were considering having kids soon, mocking the idea that planning a family should require such organization and forethought.

Governance in West Africa -- In a team meeting at work, a colleague yelled at another colleague for recommending a policy that Ghana had implemented.  "If we were even one-third as well governed as Ghana, that might be possible!  Or Rwanda!  But you know that's not possible here!"  It leads one to believe that Ghana is handily winning the West African Wager.

Governance in the Ministry of Health -- That being said, I've been impressed with how knowledgeable and competent all of my co-workers are.  They are intelligent, well educated and they have a good understanding of the issues facing their country's health care system.  I suppose I had fantasies of coming here and teaching them how to improve their health care system.  Instead, I find that this has been almost completely a learning experience (remind me to use this paragraph for my next college essay!).

Anyway, it's a good lesson for me about the value of experience and institutional knowledge over education and theoretical knowledge.  I knew a lot of health care policy generally, but very little about Cote d'Ivoire's health care system, its institutions, its way of policymaking.  The latter issues are clearly much more important categories of knowledge for my work here.  Remind me of this next time I talk about wanting to get a PhD.

Progress -- I did make a few semi-helpful suggestions during a team strategy meeting at work this past week. My French is getting better and I'm feeling increasingly competent.

Post-Coup Stability -- I don't know what it was like during the coup, but things seem pretty stable now.  The "crise" was bad, and people are clearly scarred by it, but life seems to have gone mostly back to normal.  On the surface, the country is building as if unconcerned about the possibility of future turmoil in the 2015 election.  Roads, bridges and buildings are springing up.  My office at the ministry of health is embarking on a complicated reform of the health system that will take several years to fully implement.  For a new arrival like me, the only real evidence of the crisis comes from the occasional stories of taxi drivers or Ivorians who talk about the people and things they lost.  I very much hope that the elections go off smoothly.  For the majority of Ivorians with whom I've discussed, their main concern seems to be stability.  One cab driver told me that he doesn't care who the president is, that his president is his children and trying to give them a better life.

Cultural Differences -- In the bathroom at work (in the Ministry of Health!), there is a sign above the sink that says "Interdit de pisser dans le lavabo" ("Urinating in the sink is prohibited").

Wednesday, December 18, 2013

December Observations on Life in Abidjan

Language in Cote d’Ivoire – Language stuff is very interesting here.  I think it might be the best place in the world to learn French.  Unlike most places in Africa, French is a native language for almost everyone.  And unlike France, Belgium or Quebec, people speak very little English, so you don’t even have to battle over which language to use. 

In public life, Abidjan is almost exclusively French speaking.  Cote d’Ivoire has ethnic languages, but there are so many ethnicities with so many languages that Abidjan residents speak almost exclusively French with one another.  Even in remote regions, French is the language of school instruction, so everyone is a native speaker, or close enough.  The Burkinabe and Guinean immigrants don’t always speak as well, and their accents are thick, but they are from Francophone countries, so they still speak better than me. 

This hodgepodge of French dialects makes for a forgiving learning environment.  There are so many accents and dialects that people just assume that my poor French is an odd dialect.  I ask taxi drivers to guess where I’m from and they always guess France. 

And very few people speak English.  Not even my highly educated colleagues.  They clearly studied it in school and sometimes hear it in movies, but they are not accustomed to using it in daily life.  And the cab drivers and vendors don’t speak at all, so there’s not even the temptation to use it in daily interactions.

(Perhaps I’m not giving France enough credit as a place to learn French.  Paris is very cosmopolitan, and that’s the place where I’ve been, but surely there are rural regions in France that are more Francophone than Abidjan, yet just as non-Anglophone.) 

Abidjan Natives and Unicorns – Abidjan is a bit like Paris or Washington DC in that no one is actually from Abidjan.  Everyone is from a village in one of the regions, and they moved here for work.  Even if they were born here, their family is from the village and they go back for festivals. 

The Lecture Circuit – This past Saturday, I gave a presentation for a class of high school students on The Role of Girls in the Classroom in the U.S.  It was in English at CUSA (Connect USA), an English language institute run by an Ivorian friend here in Abidjan. 

I’m a nervous public speaker, but it turned out to be a lot of fun.  I asked the girls whether they wanted to have careers and why.  This being a classroom of upper class kids, all of them wanted careers, with the main reason being that they wanted to be “independent” of their husbands so that their husbands can’t tell them what to do.  I then asked the girls whether they would like to earn more money than their husbands, to which they replied that yes, that would be great. 

I then asked the boys whether they would be okay with their wives earning more than them.  Absolutely not, they all said.  “If the wife earns more than her husband, he cannot tell her what to do,” one of the boys informed me.  I then asked how many of the boys agreed with the following statement: “My wife should have to do what I say, but I should not have to do what my wife says.”  Nearly all agreed.  This set us up for the big reveal, of course, where I told them that my wife earns more money than me, which of course brought gasps of shock. 

The students were really fun.  They spoke surprisingly good English (for Cote d’Ivoire) and they seemed to enjoy the classroom debate – I haven’t been to a regular class here, but I assume that school is shaped by the French model of sitting like statues while a professor drones on about theory.  They were also very well behaved.  The discussion was spirited, and many were eager to speak, but nobody spoke without being called upon, although they did wave their hands a bit wildly and call “Sir! Sir! Sir!” in hopes of being called upon. 

Monday, December 9, 2013

More Observations from Yamoussoukro

More Observations from the Atelier National de réflexions sur une Strategie Nationale de Financement Basé sur la Performance en Cote d'Ivoire in Yamoussoukro. 
  • On Friday, the last full day of the workshop in Yamoussoukro, I was nominated “president” of my workshop group.  For context, at the beginning of every daily workshop, each group nominates a president.  The president's job is to call on people to speak and to keep the discussion moving and the work on schedule.  My nomination was out of politeness, not out of any sense of Africans deferring to Americans; I had been pretty quiet the previous day, and I believe they were trying to be inclusive. 
  • Being president was a very stressful, very memorable experience.  Everyone is quite formal; they call you "president" or "monsieur/madame le/la president" throughout the time that one is president.  Things quickly descended into chaos though.  At the best of times, it takes a very strong leader to keep control of these group-writing sessions, and my linguistic and cultural ignorance were huge obstacles.  Even if I spoke perfect French, the cultural unknowns made effective leadership very tricky (Should everyone be allowed to express their viewpoint on every issue? Am I allowed to interrupt government officials 30 years my elder?).  And my lack of Ivorian institutional expertise left me completely unable to contribute on several important points (there was a long debate about exactly which Ministry of Health offices should be involved in regulating the “purchasing agent”).  And my French is far from perfect.  The upshot was that I completely lost control of the meeting.  Everyone ended up arguing about tiny, esoteric points for the first four hours.  The senior group member kept on giving me reproachful looks and he publicly "exhorted" me to take better control of the meeting, but it was not to be.  I implored the group to move forward, but was completely powerless to move things forward as I might have been able to do in English.  Finally, with 45 minutes until we were expected to present to the wider conference, the group seemed to confront the reality of our time constraints.  We threw together the final 75% of the work in broad, panicked brushstrokes during that last half hour and presented an adequate enough final product in the restitution session. 
  •  In fairness to my Ivorian colleagues, this was about the same as most group work projects I’ve experienced.  At Booz Allen, we spent the first week writing scripts via group and it followed the exact same pattern.  We would spend an entire morning arguing about comma placement in Script #1, and then write the last four scripts in an hour.  The work group in Yamoussoukro was a bit panicked at the end, but probably not memorably so for most of the group members. 
  • Participating in workshops in a different language is fun because it allows you to zoom out and appreciate the quirks of human nature.  When you can’t fully follow the semantic thread of the conversation, you pick up on body language: adults roll their eyes or refuse to make eye contact with a person who is disagreeing with them.  They spend 90 minutes on facebook, completely oblivious of the conversation, but then their laptop battery runs out, so they join the conversation and then immediately get so fixated on a point that they won’t let the group move past it for half an hour. 
  • The drive home from Yamoussoukro was a fascinating cultural experience.  I rode back with four of my colleagues at DPPS.  Our driver, Touré, was the most junior member of the team.  He was very offended when I tried to put on a seatbelt, assuring me that he was a terrific driver. 
  • The freeway is one-lane, so passing other cars is a necessity.  Our driver was a decent enough driver, and not overly aggressive, or at least not overly aggressive compared to the Abidjanais cab drivers.  We passed cars regularly, and for the most part without great danger.  But I dozed off after a couple of hours, and I woke up to screams and found our car accelerating towards an oncoming pickup truck while another pickup truck blocked our path back to the safety of our lane.  We survived that, but then, half an hour from Abidjan, the driver lost concentration for a bit and almost swerved off the road.  My supervisor, woke up with a start, and immediately yelled at the driver for his reckless driving.  The rest of the car chimed in, and the driver got so offended that he pulled off the side of the freeway and stormed off to smoke a cigarette to calm himself down.  He eventually returned, having apparently resolved to enact some revenge.  We spent the next 90 minutes behind a semi-truck that was traveling 15 miles per hour and spewing horrible black smoke.  As further punishment, the driver turned off the car radio and we sat in silence (although he did put in earphones for himself to listen to music from his smart phone).  The driver’s tantrum didn’t even have the desired effect, as my supervisor had lapsed into a deep slumber in the passenger seat.    
  • After the long journey crammed into the middle of the back seat, I was pretty eager to get home, and I even offered to take a cab so that the driver wouldn’t have to drive me all the way back.  He wouldn’t hear of it though and insisted on taking everyone back to their own houses.  We started by dropping off a coworker whose house was situated on a dirt road on the outskirts of the far opposite side of our sprawling capital.  He insisted that we all come in for a beer, and the group, somehow warmly reconciled by now, happily accepted, and we chattered happily about the tranquility of the remote location.  We then headed to my place on the other side of Abidjan, where I couldn’t help but invite everyone in for a second beer. 
  • It was a very long day and a long week, but very good for my French and for my understanding of the Ivorian health sector.  So long as I concentrate, I now have little trouble following the lectures or group discussions at the workshop.  I learned a good amount about both the structure and implementation of our Performance-Based Financing program, as well as institutional insights that are never written into formal government documents.  I’m still not at a place where I can understand my Ivorian colleagues when they laugh and banter in a personal setting, but I’m improving and, on good days, I feel optimistic that I will get there. 

Friday, December 6, 2013

Yamoussoukro Observations

Observations from Yamoussoukro - December 4-6, 2013 
  • On Wednesday morning, I took a bus from Abidjan from Yamoussoukro, the bizarre nominal capital.  It was the first time I’ve taken a bus in Cote d’Ivoire and I was pleasantly surprised at how easy it all was.  The ticketing office was quite professional, with standard prices and official printed tickets.  There was a terminal with benches, a television set and no panhandlers.  The bus itself was mainly middle class.  Several people in my vicinity pulled out books during the trip.  It was a bit crowded (there were about 80 people squeezed into a normal sized travel bus), but clean and secure.  Out of 80 travelers, I was one of two Westerners and there was an Indian as well. 
  • The bus had a couple of television sets that played an Ivorian sitcom throughout the trip.  The volume was a bit low and I had trouble understanding the dialogue, but it seemed like most of the plot centered around older men checking out or flirting with attractive younger women and then getting yelled at by their wives.  This is apparently a very relatable concept, as the passengers particularly enjoyed these scenes. 
  • I’m now in Yamoussoukro for a workshop to produce the national strategy paper for implementing “Performance-Based Financing.” 
  • We’re staying in the Hotel President, the nicest hotel in Cote d’Ivoire.  It’s lovely, the rival of any hotel I’ve stayed in.  I’d make snarky comments about the cost, but I know that we’re actually paying a very reasonable price for room, board and conference space.  And in fact it’s the World Bank paying.  And I’m quite confident that the cost is significantly less than the State Department paid for our Fulbright Pre-Departure Orientation.  Fair is fair, I guess. 
  • Once again, most documents are produced via group sessions.  Every afternoon, we divide into groups to produce some sort of document or presentation which we then present to the entire conference at the end of the day. 
  • A fun realization about group workshops: counter-intuitively, the period after lunch is often the most productive.  Post-coffee break, the pedantic among us will spend hours debating thrilling semantic issues such as whether the “government” or the “government budget” is a “source of revenue.”  Post-lunch, lethargy takes over, and the obstinate become subdued enough that the group can actually get work done. 
  • We had a moment of silence at the beginning of today's session in honor of Nelson Mandela.  
  • Google Glass with face recognition would be incredibly useful in government conferences. 

Thursday, November 21, 2013

Observations from Abidjan - November 10-21

More observations from the past couple of weeks here in Abidjan:
  • It's quite satisfying to feel more comfortable with the culture here.  When taxis or street vendors try to rip me off, it's now amusing rather than stressful.  One does start to feel a certain pride about it, and it's easy to see why the "old travelers" -- those delightful snobs who have spent significant time in developing countries -- can become so insufferable about Africa novices.  
  • Learning a language -- particularly French -- as an adult is such a long road.   I often feel like I've stagnated or that my progress is so slow that I'll never achieve true fluency.  I've gotten to the point where small talk and business interactions are no problem at all.  But the nuances still escape me.  Being able to hold a conversation in French is one thing; being witty or interesting or fun at a party in French is quite another.  These are subtle and difficult skills that one spends a lifetime honing even in one's native language.  
  • Likewise, French at work has been a major barrier to integrating myself into my job here.  My co-workers use a lot of Ivorian slang when they speak between themselves.  I miss out on the nuances of conversation and then there are all sorts of technical terms that I don't recognize.  I spend a lot of time fake laughing at things that I don't understand, which I dislike, but it's a lesser evil than asking someone to repeat something every 15 seconds.  Also, the nuances of workplace interactions with supervisors and co-workers often require a subtlety for which my clumsy French is ill-equipped.  My French will continue to improve, and it already has improved a great deal since I've been here.  But on those days where my co-workers are laughing together and I'm grasping at straws, trying I'm trying to cling to the thread of the conversation, it can be very frustrating.  I suppose I'll never be truly fluent; just progressively less incompetent.  
  • During a recent conversation with a Belgian Congolese (white Congolese-born Belgian) businessman who has spent his entire life in Africa, he told me that the corruption here in Cote d'Ivoire is worse than it's ever been.  That's probably to be taken with a grain of salt, since he's only really been based in Abidjan for the past few years.   
  • I mentioned in a previous post that there are usually chickens running around near restaurants and fruit vendors and cell phone credit vendors.  I still don't totally understand how they keep track of which chickens belong to who.  And what if one of the chickens gets hit by a car?  The taxis make no effort to avoid the chickens, sometimes accelerating towards them.  There are also chickens that run around outside my office, cock-a-doodle-doo-ing with great gusto throughout the afternoon.  Also, you constantly see chickens crossing the road here, which never gets old.  
  • It rains here most days, but rarely for longer than 15-20 minutes.  
  • As an indication for how far off the map West Africa is, "Ivorian" is not in the lexicon of my cell phone (purchased here in Cote d'Ivoire!).  
  • Sauce gumbo is a popular Ivorian sauce made from a vegetable called gumbo.  It's one of the more vegetarian friendly dishes around.  Unfortunately, I'm pretty sure that gumbo is French for snozzcumber.  
  • I'm leaving tomorrow morning for a week in San Francisco with Sheila and family and friends.  

Sunday, November 17, 2013

More on the Rights-based Approach

Feminist Out Of Water had a good post about the "rights-based approach" and I wanted to respond to a few points.  She starts by articulating several of the critiques of the rights-based approach made by Easterly and Blattman.  She counters these critiques several arguments about freedom and inequality and about the importance of consulting the poor in policymaking:
We are trying to alleviate poverty because poverty is bad. When we say poverty is bad, what we mean is that it is wrong. When we say it is wrong, what we mean is that it is unjust, unfair, unequal, and inhibits freedom. WHOA, I know, nobody likes to make this jump because now we are talking about normative things instead of meaningless things like “efficiency.” 
But I think these motivations for eliminating poverty are too broad and all-encompassing.  Eliminating poverty is not a way to redress all of the world's wrongs, just one very specific and important wrong.  In fact, I believe that defining poverty as a combination of vast and mushy concepts like injustice, inequity, inequality and lack of freedom is more likely to make the conversation "meaningless," than discussing "meaningless things like 'efficiency.'"

FOOW also devotes significant time to the argument of freedom as non-domination, an argument that I also find too broad:
The reason we humans want to alleviate poverty is because we want to increase freedom for all humans. This is because poverty undermines democratic equality and creates the ability for the wealthy to dominate and oppress (whether directly or indirectly) the poor. This means that the poor are not free if you see freedom as non-domination, which I think is a great way to understand freedom. You can be dominated by your government, through torture or imprisonment. Or, you can be dominated by a multinational corporation, that, with vast wealth and power, can take land away from you without your permission. Or, you can be dominated by your husband, if you are a victim of domestic abuse. There are many way to be dominated. The point is that people should not be so unequal in net-worth or in social standing that they can dominate each other or be dominated by each other or by institutions. It is up to us humans to design institutions that make this a reality.
FOOW says that domination undermines freedom and notes that "there are many ways to be dominated."  But I would argue that there are too many ways to be dominated for "domination" to denote a lack of freedom.  She seems to be arguing that if you live in a society where some people's land has been taken away by a multinational corporation, this does not mean that you yourself are unfree.  Or is it just the person whose land was taken away?  Or him and his neighbors?  Or him and his neighbors and everyone else whose property could possible be taken (now we're up to most of society).  This seems like an awfully big leap.  I don't believe that the existence of companies or people who do bad things shows that the people of that society are unfree.  This would mean that basically all of humanity is unfree.

She also criticizes economic arguments to policy, in which policymakers take into account silly considerations such as cost-benefit analysis.  
We cannot just say, well there is more freedom being enhanced than taken away, and call it “efficient.” Like good – bad > 0. These are human lives we are talking about not mathematical calculations. Moreover, this kind of calculation is not an abstract and morally neutral or practical or pragmatic solution, this is a clear adherence to a moral philosophy that is called utilitarianism. It is one moral philosophy among many, and has not been the premier moral philosophy for the past half-century in any other field than in economics, where efficiency as a moral concept still reigns supreme. I think it is absolutely nuts that economics claims to be value neutral while holding up utilitarianism as their moral dogma, but whatever, that is for another post.
FOOW seems to be arguing for a "do no harm approach" to policy, which I think is extreme and unrealistic.  All government policy does harm to one group or another.  Even a lack of policymaking or a delay in policymaking does harm to one group or another (see United States Congress).  In a world of limited government budgets, a right to health care or a right to a speedy trial, inherently limits the right to clean water or the right to adequate housing.  The only real conclusion that she seems to be making is that it is important to consult the poor more.

And this, for me, is the main problem with FOOW's argument.  There are lots of interesting arguments about freedom and inequality, but no real compelling argument for the rights-based approach.  She seem to be arguing for consulting the poor more, without really do not provide any arguments for why the rights-based approach does this more effectively.  

Sunday, November 10, 2013

More Abidjan Thoughts

Observations from the past few weeks here in Abidjan:
  • I had strep throat last week, and possibly malaria as well.  I'm better now, but this was a barrier to blogging the past couple of weeks.  
  • Internet USB keys here are very convenient.  You can buy a USB key and insert it into your computer whenever you need internet and it provides you with a 3G connection.  I assume that this technology exists in the U.S., but I was completely unaware of it.  
  • At the ministry of health, my direction is now pushing forward a plan to introduce "performance based financing" into the Ivorian health system.  This should be an exciting project and I imagine that it will be my core project during my time here in Cote d'Ivoire.  
  • A lot of professional documents here are written collaboratively here.  In fact, at every government conference, workshop or commission that I've been to, the goal has been to produce, via group, some sort of document.  This is in stark contrast to the U.S., where documents are composed individually and circulated for editing, and where workshops and seminars are often a waste of time.  Here, the workshop is the most important work activity; everyone comes together, works hard, and produces a policy paper collaboratively.  Still, based on what I've seen so far, I'd probably choose the U.S. model for producing collaborative work.  I do like that the Ivorian model encourages such a high level of collaboration and participation.  But it does not encourage outside research.  It's a closed universe, where a group of people will sit inside a room drafting a strategic plan without bringing in outside research, thereby failing to take advantage of the wealth of easily accessible information available via internet.  It's possible that these judgments are premature.  I have only been to a handful of workshops and commission meetings so far.  
  • Abidjan is generally pretty nice.  It is green, there is not too much garbage on the streets, there are lots of nice buildings.  Still, it's not quite as well kept as, say, NW Washington DC.  The main reminder is that my fingernails and the bottoms of my feet are usually dirty here.  Lots of dust flying around always.  
  • In general, I've been positively surprised by the level of social capital here.  To get window curtains made, you go to the store, select your curtains and then come back in a week to pick them up.  They don't demand money up front, and it is quite possible that you would never return and they would be out the cost of the materials and the labor.  When we got our furniture made, we left a sizable deposit to allow the carpenter to buy supplies, and, while he wasn't a great carpenter, he did eventually deliver all of the furniture that we had ordered at the price he had quoted.  
  • That being said, I left my cheap cell phone in a taxi last week, and the finder did not make any attempt to return it, despite text messages promising a reward.  
  • There is no daylight savings time in Cote d'Ivoire.  Which makes sense, this being so close to the equator and all.  Days are always about the same length here.  Sunrise around 6am and sunset at 6pm.  
  • There is an odd competition here among ex-pats to see who can pay the least for taxi rides.  I understand the desire to be well adapted to Ivorian culture, but I still don't really understand bragging about negotiating a particularly low fare with a cab driver.  Would you brag about how little you tipped your waiter at lunch?  Is there an ethical difference between the two?  

Sunday, October 27, 2013

Partisan narratives and why America's government fails

Keeping with my kick of reading about making government work, I liked this from Scott Sumner on why the U.S.'s government often functions so poorly:
America has two political parties:
1.  One is so anti-government that they refuse to do serious thinking about how to make government work.
2.  The other is so pro-government that they refuse to make the tough choices necessary to make government work.

Friday, October 25, 2013

Book Review: The Anti-Politics Machine

This was an intelligent and thought-provoking book.  It is a terrific deconstruction of the institution of "development."  

The subject of the book is a development project in Lesotho.  It discusses how the Canadian International Development Agency (Canada's USAID) twisted a complex situation into a simple model so that it could apply its standard "development" prescriptions to the situation at hand.  The resulting project was a failure and the book examines exactly why it was such a failure.  

Adapted from the author's PHD dissertation, the book is a bit dry and plodding at times, but it is lucid and full of terrific analysis.  

Some of my favorite passages: 
Often, the question was put to me in the form "What should they do?", with the "they" being not very helpfully specified as "Lesotho" or "the Basotho".  The "they" here is an imaginary, collective subject, linked to utopian prescriptions for advancing the collective interests of "the Basotho."  Such a "they" clearly needs to be broken up.  The inhabitants of Lesotho do not all share the same interests or the same circumstances, and they do not act as a single unit.  There exists neither a collective will nor a collective subject capable of serving it.   
When "developers" spoke of such a collectivity, what they meant was usually the government.  But the government of Lesotho is of course not identical with the people who live in Lesotho, nor is it in any of the established senses "representative" of that collectivity.  As in most countries, the government is a relatively small clique with narrow interests... Speaking very broadly, the interests represented by governmental elites in a country like Lesotho are not congruent with those of the people and in a great many cases are positively antagonistic.  Under these circumstances, there is little point in asking what such entrenched and often extractive elites should do in order to empower the poor.  Their own structural positions makes it clear that they would be the last ones to undertake such a project. 
In a similar vein: 
If the question "what should they do" is not intelligibly posed of the government, another move is to ask if the "they" to be addressed should not be instead "the people."  Surely "the masses" themselves have an interest in overcoming poverty, hunger and other symptoms of powerlessness... Once again, the question is befuddled by a false unity.  "The people' are not an undifferentiated mass.  Rich and poor, women and men, city dwellers and villagers, workers and dependents, old and young; all confront different problems and devise different strategies for dealing with them.  There is not one question -- "what is to be done" -- but hundreds: what should the mineworkers do, what should the abandoned old women do, what should the unemployed do, and on and on.  It seems, at the least, presumptuous to offer prescriptions here.  The toiling minters and the abandoned old women know the proper tactics to their situations far better than any expert does.  Indeed, the only general answer to the question, "What should they do?" is: "They are doing it!." 
This was also interesting: 
If one takes the "development" problematic at its word... the absence of growth in agricultural output... can only be considered an unfortunate mistake.  But another explanation is possible.  if one considers the expansion and entrenchment of state power to be the principal effect -- indeed, what "development" projects in Lesotho are chiefly about -- then the promise of agricultural transformation appears simply as a point of entry for an intervention of a very different character.  In this perspective, the "development apparatus in Lesotho is not a machine for eliminating poverty that is incidentally involved in bureaucracy; it is a machine for reinforcing and expanding the exercise of bureaucratic state power, which incidentally takes "poverty" as its point of entry. 

Sunday, October 20, 2013

Things I learned this week in Abidjan

Notes from this past week:
  • Animals are harder to remove from day-to-day life here.  There seems to be a lizard living in my air conditioner.  As I write this, there is a centipede crawling up the wall across the room from me.  My roommate found a lizard in her bed the other day.  If you look closely at any table or counter, you'll likely see very tiny African insects crawling around on it.  Happily, mosquitoes haven't been much of a problem though.  
  • In a way, it's cheaper and easier to eat healthy here.  Processed supermarket food costs significantly more than fresh food from nearby markets.  The animals are always locally grown (there are chickens waddling around just about every block) and presumably antibiotic free.  The policies that create this -- lack of local food processing companies, high tariffs on foreign imports of processed food, tons of local food producers and sellers willing to earn low margins, lack of food safety monitoring -- aren't really replicable in a developed country.  
  • All that being said, vegetable-based meals are not common and portion size is not helpful to the calorie conscious.  
  • Eating out at a local restaurant (a maquis) is generally cheaper than making a meal at home, particularly if you're using western ingredients for your meal at home.  The main expense of going out to eat is time; you should count on spending at least 45-90 minutes for a meal.  
  • Vietnamese spring rolls (nems) have been adopted into Ivorian culture.  They are cheap and plentiful here, and some Vietnamese places are run by Ivorians.  
  • In the same way that a crepe in Washington, DC is expensive and of poor quality, a hamburger or pizza here is always (relatively) overpriced and disappointing.  The extra money that you're paying for a burger here isn't because you're paying for a deluxe burger but because you're paying for the cultural experience of "American food."  
  • The lack of activity options doesn't really hurt my quality of life.  In DC, there are several soccer leagues, basketball leagues, kickball leagues and a dozen other sports that I could be playing any day of the week.  Here there is soccer on Wednesday in Deux Plateaux, volleyball on Thursdays at the American embassy and ultimate frisbee on Sundays at the Lycée Classique.  I would never play volleyball or frisbee over basketball in the U.S., but they are 90% as fun and the lack of choice can be liberating (I always just assume that Wednesdays here are for soccer, rather than trying to decide which day to play).  Likewise, with the social scene.  The plethora of nice bars and social activities in DC could be stressful, as it was disappointing not to choose the most fun Saturday night activity.  Here, there are a handful of ex-pat bars and usually just one or two activities per weekend, often with many of the same people.  You may or may not like going to see Diego's blues band, but that's what people are doing most Friday evenings here.  If you want to see people, you go and make the best of it.  
  • I suppose this is all just a readjustment of my hedonic baseline.  I suppose that when I move back to DC, I'll enjoy the variety of options for the first couple of months, but then re-adapt.  

Friday, October 18, 2013

Why bureaucracy matters

This is my latest intellectual trip, especially the topic of public service delivery. It combines a lot of things I’m interested in – institution building, rule of law, making government work. I also like it because it touches on the existential question of all policy: what does government do well and how can it do this better? Where should government be involved and where not, and how can it function well where it exists? In the same way that people are starting to realize that the first rule of development should be to do no harm, I like applying this idea to all policymaking.  My current fellowship/job gives me a terrific platform to view this within the context of a developing country government.

Happily, I'm not alone here.  Chris Blattman thinks "'bureaucracy' will be the most topical development topic in five years," so I might as well get an early start.

Here’s a good passage from one of the foundational articles in this topic:
It is now widely appreciated that government failure may be as important as market failure, and the mere existence of the latter does not necessarily justify government intervention.  To the extent government intervention is called for, this does not automatically mean direct involvement of the state in economic activity and could entail indirect involvement through partnership with the private sector, and the “third sector” consisting of voluntary and community organizations.
And another:
The traditional model of state provision assumes away incentive problems, assuming that the government can stipulate and enforce a level of provision. It implicitly assumes that individuals who work in the public sector need little direct motivation to pursue the social good. Rewards therefore depended little on performance. The implicit assumption was that teachers, health care professionals and bureaucrats are publicly spirited and that this was enough. 
The article has lots of other little tidbits worthy of further exploration.  For instance:
Persson and Tabellini argue that proportional representation and parliamentary systems provide better  incentives for provision of public goods. 
Such an argument may help to explain (among other reasons) why Americans seem to get so little bang for their taxpayer dollar compared to, say, Germany.

Monday, October 14, 2013

Improving human resources in the health sector

The focus of my work conference this past week was on "how to improve human resources in the health sector."

There are several problems with human resources in Cote d'Ivoire's health system, but the main one is that there simply aren't enough people.  Not enough doctors, nurses, midwives, or health officials.  A lot of people left during the crisis this past decade, and the existing schools and training institutions are poorly equipped to fill the gap.

The schools are already overburdened and there is concern that increasing the ratio of students to teachers would decrease quality to unacceptable levels.  The Ministry of Health would like to create more schools and hire more staff for existing schools, but there are a lot of competing demands for funding.  They will probably be able to open a couple of schools and hire some more teachers, but not enough to produce the number of health sector personnel that is needed.  So what to do?

One option that was discussed is accrediting private schools to train health workers.  But a number of people were skeptical that this could work in a country of Cote d'Ivoire's level of development.  They cited recent privatizations of health training in Senegal and Benin as examples of why accrediting private institutions would not work in Cote d'Ivoire.  I was curious about the factual basis for these concerns.  Does a country need to attain a certain level of economic development or administrative sophistication before such public-private partnerships can function effectively?  Information on this topic is not easy to unearth.  The Center for Global Development discusses in a recent report on Partnerships with the Private Sector in Health:
Policies, such as those related to contracting or accreditation, that engage and influence the private sector are complex and challenging They require specialized skills and new practices built on experiences in other countries and basic principles of economics, regulation, business, and other fields The technical assistance available to public officials in developing countries, however, typically offers little support and expertise on private-sector engagement. 
The language is quite general, but it suggests that accreditation can be challenging for less experienced administrative bodies.  The opposing (libertarian) argument would be that it's unclear why the government should be so much better at creating effective schools and training institutions for health workers.  I don't yet have enough experience in developing country economies to know how strong this argument is.  On the one hand, if a private institution is churning out poor quality workers, won't hospitals and clinics stop hiring such workers?  On the other hand, I imagine the picture is much more complex than that.  From what I've seen, the Ivorian bureaucracy has a complex relationship with diplomas, trainings and other qualifications that I don't yet understand at all.  

I will revisit this question in a couple of months.  It seems that there are two main questions to be answered: 1) Could private accreditation of health worker training improve the human resources situation in Cote d'Ivoire? 2) And if so, what is the best way to institute a private accreditation program for health workers in a developing country?  This ASCP article provides some useful background on the latter question.  

Friday, October 11, 2013

Working at the Ivorian Ministry of Health

Notes from my first week of work at the Ministry of Health:
  • I arrived at work on Tuesday morning and the electricity was out.  They didn’t really know what to do with me, but one of the women in the office was about to leave for a week-long conference, so they sent me with her.  The conference was in Agboville, 90 minutes north of Abidjan.  I was told to go home and pack my bags and Noelle would pick me up in two hours. 
  • The conference was about how to improve human resources in the Ivorian health system.  There were officials there from several different branches of the Ministry of Health, as well as from the WHO and Abt Associates, who sponsored the meeting. 
  • The meetings were a bit stressful at first, as my French comprehension is still not totally up to par, and I had trouble following some of the more technical conversations.  Also, I’m the only non-African here.  It’s an odd feeling; I attract a lot of attention whenever I walk into a room.  Everyone is polite enough to pretend like it’s nothing out of the ordinary, but it’s interesting to feel the vibe of the room change when I enter.  It’s a bit of a lonely feeling and I imagine it will increase my empathy for outsiders when I return to the U.S. 
  • It’s worth noting that Abidjan doesn’t feel like this.  White people are noticed, but there they are common enough that you usually don’t get more than a brief second glance.  This is supposedly rare for Africa.  Sheila says that even in Accra she attracted significantly more attention. 
  • By the end of the week, everyone had become much more comfortable with me.  I got invited out to dinner in town on our last night, and I had some nice conversations on Thursday and Friday. 
  • There was a refreshing and admirable level of honesty at these meetings  -- it is common for government officials at an official meeting to say something like “our system of financial motivation for health workers is completely worthless,” and everyone will nod in agreement.  U.S. government would function better if public officials were so honest.  
  • On Wednesday morning, we had a presentation on “Results-Based Management” (“Le Gestion Axée sur les Resultats”).  The presenter attributed the concept to Peter Drucker and his 1964 book “Managing for Results.”  The presentation cited the fact that the Canadian government adopted this concept in the early 1990s. 
  •  We seem to be writing the official 3-year plan for how to improve human resources in the health sector. 
  • In French, to make a text comprehensible to the population is to "vulgarize" it, which says everything.  
  • At lunch, I found a hair on my plate.  I spent a moment trying to decide if it was mine before realizing that I was the only person within 25 miles with hair like that. 

Thursday, October 10, 2013

Things I learned this week in Abidjan

Observations from last week in Abidjan:
  • Taxi drivers have been much more honest than I had been led to believe.  One negotiates their cab fare here, and to hear some tell it, they will skin you alive if you let them.  My experience has been that they usually start a dollar or two above the market rate, and negotiate down quite easily. 
  • On Wednesday night, my cab driver was listening to a country music CD.  The juxtaposition between Dan Williams' music and the drive across Abidjan at rush hour (we drove on the sidewalk for several blocks -- I know this must seem like an exaggeration but it isn't) was one of the cooler moments I've had here.  It would have made a great scene for a film.   
  • The climate is waaaay better than I had been expecting.  There hasn't been an oppressively hot day since my arrival and most days it's actually pretty pleasant.  Apparently, the dry season is much hotter, but I had expected every day to be unreasonably hot, and that is certainly not the case.   
  • I moved into my new house last weekend with the three other Fulbrighters.  It’s a spacious four-bedroom house, with a small yard on a pleasant residential street.  We’re in Deux Plateaux, a couple of blocks from Rue des Jardins, one of the more fun streets in Abidjan. 
  • Rue des Jardins is fun because it has restaurants (particularly Vietnamese and Lebanese), as well as cafes, an ice cream shop, a supermarket and a very decent French pastry shop. 
  • Rent is less than half of what one would pay for a similar place in DC, but still supposedly quite expensive by developing country standards.  
  • Moving in was complicated by the lack of social capital and the lack of trust in the legal system.  We didn’t want to pay anything until basically the moment we moved in and I felt stressed that perhaps it was all a scam and our money would be stolen.   For their part, they made us pay nine months of rent up-front -- six months of rent, along with three months of security deposit. 
  • Lots of lizards here, some with brilliant orange stripes along their backs. 
  • The ravens have white breasts. There are an extraordinary number of them here, particularly at sunset when they all take to the sky and downtown Abidjan looks like it’s in the middle of an apocalyptic bird uprising. 
  • Most streets here don’t have names, just numbers that nobody knows or bothers with. To get somewhere, you have to know a landmark nearby and direct your driver from there.  
  • The local furniture makers here don’t have stores or warehouses; they occupy patches of land in throughout the city where they display their wares.  We bought all our furniture for our house from one of these carpenters.  It was a mostly painless and effective process.  They built several beds, desks, chairs and desks for us, according to our specifications and delivered them; however, the one problem – and it is a significant problem – is that my bed smells like mold.  Trying to figure out how to get this fixed.  

Monday, September 30, 2013

Things I learned this week

Observations from my 2nd week in Abidjan:
  • This is apparently common to all developing countries, but there is no better feeling than breaking a large bill here.  Change is almost impossible to come by, and one is in a constant state of worrying about having enough small bills.  
  • In meetings, Ivorians clap to demand silence.  
  • The internet is a bit slower than in the U.S., but usually stable and completely adequate for my daily needs.  Netflix and Hulu do not work here; iTunes and Spotify work as normal.
  • The traffic here reminds me a lot of Santa Cruz.  There aren't a ton of cars on the road, but neighborhoods are spaced far apart and there are not enough roads to link it all.  
  • There is a lack of rules here that is both liberating and terrifying.  On the good side, one can basically go wherever one wants with no consequences.  I don't think an authority figure has told me not to do something since I arrived here two weeks ago.  On the bad side, renting a house is terrifying; on Wednesday, we'll pay nine months of rent for our house, and we're concerned about the lack of legal recourse.  
  • There is a startling amount of conflicting and sometimes just bad information that circulates among ex-pats.  Our housing search has been absolutely ludicrous.  We'll find a house at a given price, and some people will tell us that the price sounds too good to be true, while others will be scandalized at how much we're overpaying.  We likewise get contrasting information from our fellow ex-pats on acceptable modes of transportation, good/fun/safe neighborhoods, and the need for security guards.  
  • Two weeks into my stay here, I see poor neighborhoods differently.  In my first few days, I would drive or walk through a poor neighborhood (and most neighborhoods are poor) and feel worried for my safety.  Mostly though everyone is just going about their daily lives.  Crime exists here, but I've yet to be targeted, and I've yet to have a legitimate reason for concern.   
  • Sheila tells me that people are far more accustomed to white people here than they were in Ghana or Burkina Faso.  Most people don't look twice at us, although cab drivers honk at us in the hope that we're interested in a taxi (which we often are to be fair).  
  • There seems to be a decent quality pick-up basketball game at the Lycée Classique in Cocody.  

Sunday, September 22, 2013

Things I learned this week

Things I learned during my first week in Abidjan:
  • Abidjan is less dense than I had imagined.  I imagined something closer to slums packed with humanity.  Instead, there is a shocking amount of open space.  Wealthy and middle class neighborhoods have huge swaths of basically undeveloped land.  Even in fully developed areas, Abidjan looks more like L.A. than New York. 
  • Human labor is very cheap here in Abidjan.  You can rent somebody's car for $50/day.  Car and driver = $60/day.  
  • As a result, most things are very cheap here.  Lunch on Friday (fried fish, cous cous and some chopped tomatoes and onions) cost $1 from a street vendor.  We were given a bowl of water to rinse our hands before eating.  It is customary to eat with our hands, although when I was hesitant, they brought me a spoon.  
  • I did not get sick from the street vendor food and I've yet to have any stomach problems.  All meat that I have eaten has looked and tasted how it was supposed to look and taste.  
  • Taxi rides are also very cheap.  Petrol must be heavily subsidized, since cars are apparently very expensive.  
  • Apparently, cars and most other imports are quite expensive.  Multiple people have said that you can buy a car in the U.S., have it shipped to Cote d'Ivoire, and sell it for double the original price in the U.S.  
  • There is something very feudal and mercantile about the economic system here.  There are apparently check points throughout the country where police officers (or gangsters) demand a "toll" from vehicles carrying cargo.  It reminds me of Paul Bairoch's description of 17th century Europe where a merchant would have to pay a toll every 5 miles on average.  
  • I have been pleasantly surprised by the food, both West African and "ethnic" (e.g., Vietnamese) -- much better than Sheila had led me to believe based on her experience in Ghana.  I'm tempted to think it's a difference between ex-English colonies and ex-French colonies, but that is probably lazy.  West African food does not have much in common with French food so far.  
  • That being said, one can get croissants and baguettes here.  The croissants aren't as good as in Paris, but are better than the median croissant in Washington, DC.  I haven't yet tried the baguettes.  
  • Many areas of Abidjan smell faintly (or strongly) of human waste.  
  • The embassy community seems pretty isolated from Ivorian culture.  Several ex-pats have expressed a degree of condescension about embassy lifestyle on issues ranging from transportation to antimalarials.  
  • Houses of embassy staff in Abidjan are amazing.  They live in large villas with multiple bedrooms, spacious living rooms, cozy furniture, air conditioning, multiple security guards, and large backyards that sometimes have swimming pools.  We are staying with a foreign service officer and his wife and they have been extremely hospitable, providing us with food, lodging and even a driver most days.  
  • Help or "domestiques" seem to be a staple of ex-pat life.  We are considering hiring someone once we have our own apartment.  We like the idea of being able to supply someone with consistent and stable income over several months, and an above market rate daily wage would be very affordable for us. Sheila also likes the idea of being able to work on her French. Needless to say, having someone help with daily errands sounds nice as well.  
  • We went to dinner on Saturday night at a restaurant in an open field with a band playing.  The band played West African music and latin salsa.  They played for more than 90 minutes without a break.  Afterwards, they passed around a survey asking how they could improve (and also asking for a donations).  
  • There are fewer rats in Abidjan than in Washington, DC.  

Sunday, September 15, 2013

Why I'm excited for Cote d'Ivoire

I leave for Abidjan in a couple of hours.  I keep waiting to get nervous, but it hasn't really happened, perhaps because our entry looks likely to be smooth.  Someone from the U.S. embassy will be coming to pick us up at the airport and I'll have Sheila with me, so there isn't much to worry about.

Instead, I'm just really excited about it all.  Anticipation supposedly comprises a big part of happiness.  People are at their happiest in the weeks leading up to a big vacation or other happy event.  I'm trying to savor this last bit of excitement and embrace the anticipation as part of the experience.  You only move to Africa for the first time once.   My expectations are big and it would be difficult for any experience to live up to them.

Abidjan should bring great highs and lows, and hopefully rich memories.  Those memories are another big part of happiness.  Sheila and I have discussed this issue a lot, and we believe that it is necessary to seek out experiences with greater peaks and valleys.  Such moments are felt more intensely and they live longer in the memory.  Novel, exciting experiences may even make life feel longer.  These memories make us happy, and we've prioritized a life of adventure.

I'm excited to explore such a new culture and lifestyle.  My favorite part of traveling is learning about the nuances of life in a new place.  Abidjan promises to be very different to from anything I've known before.  As a brief example, the Ivorian conception of bribery sounds almost incomprehensible.  As a returning Fulbright fellow told us during orientation, "In Cote d'Ivoire, bribes are totally optional.  You can say, 'I'm sorry, maybe next time.'"  My American brain has difficulty comprehending by such a scenario, but apparently this is the natural state of affairs in Cote d'Ivoire.  A returning fellow explained that "many people just think of bribery as optional.  They call it 'dash' and it's more like a tip.  If you want good service at a restaurant, you would give a tip.  And if you want good service from a police officer, you give dash."

I'm not entirely sure how much I'll blog over the coming weeks and months, but I would like to note my personal observations as well as my policy learning.  Hopefully I'll be able to record this in a manner that is interesting to those reading this.

Sunday, September 8, 2013

Book Review: Radio Congo: Signals of Hope from Africa's Deadliest War

Radio Congo: Signals of Hope from Africa's Deadliest War by Ben Rawlence 

My 2nd "guy going to Africa" book in the past month. This was the better of the two (or perhaps just the more relevant and contemporary). 

I've never been to sub-Saharan Africa before, and I have no real idea of what to expect, which is what makes these books interesting at the moment. This was well-written and engaging. It did a good job of giving color to daily life in the Congo. The characters (both African and European) were all a bit hollow still, but they had some level of complexity and I enjoyed his ability to write about individuals as individuals rather than archetypes. I didn't find his observations to be super insightful, but the writing was lively, and I enjoyed traveling along on his adventure. 

Thursday, September 5, 2013

Book Review: The Making of a Tropical Disease: A Short History of Malaria

The Making of a Tropical Disease: A Short History of Malaria, by Randall M. Packard 

This was disappointing. I'm not sure how many times a book can re-write variations of the sentence, "Changing social and economic conditions transformed the ecological relationship of malaria parasites and human hosts, resulting in a decline/increase in malaria burden," but the author exceeded his allotment by quite a bit.  It's a useful point, and one well worth making, but I'm not sure if I've ever read a book that hammers its point so repetitively. 

Also, I'm not sure that it is a very productive argument.  Yes, improving social and economic conditions would be great for decreasing malaria, but no one argues that we shouldn't improve social and economic conditions for people around the world.  While we're working for social and economic betterment, what can we do to manage and control malaria rates as efficiently and effectively as possible?  Here the book is disappointingly quiet.  There are many discussions of failed malaria programs, but few examples of effective programs that could be repeated or adapted by poor governments in developing countries. 

This book had some useful information, and it wasn't a total waste of time, but I'd only recommend it to someone desperate to gain a bit of background on malaria and willing to plow through a lot of tedium to gain that basic background.  

Monday, September 2, 2013

Making development work: from farms to factories

Charles Kenny's article about the importance of "real" jobs is the most interesting thing on development that I've read in the past few months:
But worldwide, by far the most common way out of poverty in rural and urban areas alike is getting a job working for a company... Having a regular, paying job "may thus be the most important difference between the poor and the middle class," conclude Banerjee and Duflo. 
"Well paid" and "good" are relative terms when it comes to unemployment on a global scale... Nonetheless, these jobs are still better than other options--such as begging or hawking on the street or subsistence farming.  
So for all of the grind of the 9-to-5, the great majority of the planet would be absolutely delighted to get a position with regular hours and a regular paycheck.  And successful economic development--significantly raising incomes above subsistence--is about helping people achieve that dream...  In the long term, economic development is about moving millions off the small farm and into jobs.   

Friday, August 9, 2013

Adventures in West Africa

Last winter, I applied for a Fulbright Public Policy Fellowship in the Cote d'Ivoire.  I was applying to a few positions at the time, and I wasn't really expecting much to come of it.  But I got called back for an interview in May and then I was recently informed that I'd been selected as a Fulbright Fellow.  It was too good an opportunity to pass up.  Sheila and I have been craving another adventure, and this is exactly the sort of work that I want to do in my career.

So we're going to the Cote d'Ivoire this September.  The fellowship lasts for 10 months, so ostensibly, I'll be in Abidjan (the de facto capital) from this September until July 2014.  Sheila will come out for my first two weeks in September, and then join me at the end of 2013 for several months.  She's still negotiating with her work, but ideally she'll be able to come out for about five months and work remotely at a reduced schedule.

The fellowship itself sounds amazing.  It's a new program, now called the Fulbright-Clinton Fellowship.  According to the State Department website:
Fulbright-Clinton Fellows serve in professional placements in foreign government ministries or institutions. Fellows gain hands-on public sector experience in participating foreign countries while simultaneously carrying out an academic study/research project.
Fulbright-Clinton Fellows will function in a “special assistant” role for a senior level official. The goal of the professional placements is to build the Fellows’ knowledge and skills, provide support to partner country institutions, and promote long-term ties between the U.S. and the partner country.
For my fellowship, I'll be working in the Ministry of Health in Abidjan as a special assistant to an official there.  It's still unclear who exactly I'll be working for, but I should hear more about that in the next few weeks.

I recently attended orientation in here in DC, and it was really inspiring, probably the first orientation I've been to that made me more excited about the job.  The people were great; all had fascinating back stories and it sounds like they'll be doing really cool stuff.  It was also useful getting to talk to the returning Fulbright alums, especially those coming back from Cote d'Ivoire.  It seems like they had great experiences and that Cote d'Ivoire was the model program among the inaugural class of Fulbright-Clinton Fellowships.  My Fulbright predecessor in the Ministry of Health conducted a couple of really cool sounding health system studies and initiated a project to rebuild the national public health library.

So I leave in September.  I'm still figuring out flights and housing and vaccinations, but I'm really excited.  I'm curious to see who I'll be working for and what they'll be like.  This is likely the single biggest factor in how successful an experience I'll have, so I'm hoping to get lucky.  Either way though, it sounds like I'll have a lot of autonomy, and that a big part of my experience will be the interchange with colleagues at the Ministry of Health.  In addition to regular work projects, last year's alums taught English to colleagues and also gave lessons on computer skills such as using Google Calendar, Excel, Word and Dropbox.  I would love to be able to have some sort of policy impact, but in many ways I think the exchange of institutional knowledge will be just as important.  I'll be in a strange and unfamiliar situation, and I'm looking forward to learning everything I can about the Cote d'Ivoire health system and about life in Abidjan.

Finally, a word about the future of this blog: for my handful of readers (Hi Dad!), fear not! I will continue to post while in Abidjan.  In fact, I'm hoping to blog more than ever.  My field of work will be changing, so I'll likely be blogging a bit more about African and global health issues, and less about U.S. health care.  But this will be a good thing; it will give me a fairly unique blogging perspective and a fun niche.  If there is a health policy blog about West Africa, I have not been able to find it.  This blog may also become a bit more personal.  I anticipate having some novel and interesting experiences working in health policy in Cote d'Ivoire, and I intend to share some of them.

Wednesday, August 7, 2013

What are the major medical advances of the past decade?

The past few decades have been a bit disappointing in terms of medical advances. Cancer is still a big problem, there's no cure for AIDS, and we somehow don't really understand how to help people lose weight.  But the DMCB argues that, while medical advances have been disappointing, there have been some major breakthroughs in health care delivery.  I would argue that a lot of these are closer to "potential" or "future" advances, and that some will not generate big changes. But this is a handy list and a fun look at how the health care sector will change going forward: 
1. Downjobbing: many tasks that were restricted to highly trained specialists are increasingly being performed by non-physicians, patients and technology.

2. Social Media: patients can not only access the internet for information, they can use the internet to pool input and solicit personalized advice from like-minded individuals

3. Democratized Artificial Intelligence: In addition to social media, we’re on the verge of being able to remotely access AI to generate a reasonably accurate list of diagnoses, suggested tests and recommended do-it-yourself treatments that include the option of doing nothing.

4. The Decline of the Credential: while the academic-industrial complex will continue to churn out superbly trained physicians, massive on-line education will enable persons to gain a surprising level of lay-expertise. 

9. Medical Tourism: As the rest of the globe imports the best that western medicine has to offer minus the United States’ overhead costs, the cost of overseas air travel is no longer be an impediment to patients or insurers.
The full list is here.